Early vs delayed enteral nutrition in critically ill medical patients

This study was conducted to identify current practice in provision of enteral nutrition (EN) and to determine effects of early enteral nutrition (EEN) on length of stay in the medical intensive care unit (ICU). In this prospective, observational study, medical ICU patients were evaluated to determine their candidacy for EEN. If patients were candidates for EN and expected to remain nothing-by-mouth for 48 hours, they were classified as receiving EEN (within 24 hours of admission) or delayed EN. Thirty-six patients were candidates for EEN. Eighteen received EEN and 18 received delayed EN. In the delayed group, the median time to start of EN was 2.1 +/- 4.8 days. Median ICU length of stay was 4.7 +/- 3.5 days in the EEN group compared with 8.5 +/- 8.3 days in the delayed group. Although hospital length of stay was shorter in the EEN group, this was not statistically significant (10.4 +/- 6.9 vs 16.9 +/- 11.5 days). Time on the ventilator was significantly shorter in the EEN group vs delayed (n = 30, 3.0 +/- 4.2 vs 6.0 +/- 9.2 days). The incidence of new pneumonia was lower in the EEN group (5.5% vs 44%), but no difference was found in the incidence of bacteremia. Hospital mortality was lower in the EEN group (1 vs 7 deaths). Given its association with numerous benefits, EEN within 24 hours of admission should be encouraged and implemented by clinicians in medical ICU patients, but additional research is needed.

Ion cyclotron production by a four-wave interaction with a helicon pump

Ion cyclotron waves at approximately 0.7 the ion gyrofrequency have been observed experimentally in the large volume helicon reactor WOMBAT. These waves are highly localized along the axis of the device where a 8 cm diameter, 2 m long. Ar II plasma column is produced. Spectral measurements reveal a four-wave interaction where energy is down-converted to the ion cyclotron mode from the helicon pump. The experimental results are explained in terms of a filamentation type instability.

The effect of environmentally induced changes in the bark of young conifers on feeding behaviour and reproductive development of adult Hylobius abietis (Coleoptera: Curculionidae)

Young plants of Sitka spruce, Scots and Corsican pine were subject to high and low light, and high and low nitrogen treatments in a polyhouse experiment. The effect of treatments on resin duct size and nitrogen concentration in stem bark was determined together with feeding by Hylobius abietis Linnaeus on the stems of 'intact' plants and on 'detached' stems cut from the plant. Resin duct size was largest on Corsican pine and smallest on Sitka spruce and inherent variation in duct size between the three conifer species appears to determine the pattern of weevil feeding between species. Resin ducts and the flow of resin from them protect the stems of young conifers from weevil feeding not by affecting the total amount of bark eaten but by limiting the depth of feeding and so protecting the inner phloem and cambium. Shallow feeding may increase the likelihood of effective wound repair. Duct size was positively related to plant growth and in particular increased with bark thickness. Overall, ducts were largest in the high light treatment although species differed in their response to the treatment. It is suggested that the effects of plant size, growing conditions and transplantation on susceptibility to attack by H. abietis, reported in various studies, may be due to underlying variation in resin duct size or flow rate. The effect on weevils of superficial feeding on stems is to increase the time for reproductive maturation by reducing consumption of the inner bark which has a higher nitrogen content.

Maturation feeding and reproductive development in adult pine weevil, Hylobius abietis (Coleoptera: Curculionidae)

Maturation feeding on conifer bark by newly emerged Hylobius abietis(Linnaeus) is essential for reproductive development. When feeding occurs on young conifer transplants, this weevil causes significant economic damage. Between emergence and oviposition however, weevils feed on bark from different sources but of unknown nutritional 'quality'. The factors influencing the rate of feeding by males and females and female reproductive development were determined in laboratory bioassays using two contrasting food sources - the bark on different species of seedling conifer and on logs of mature trees. The nutritional 'quality' of bark was characterized by the concentration of nitrogen, total sugars, total polyphenols and resin. Regression models were used to show that overall, the rate of feeding on the bark of both seedlings and logs increased with weevil size and was negatively related to nitrogen concentration. The nitrogen concentration in seedling bark (mean 1.1%) was about three times higher than that of logs (mean 0.4%). The rate of reproductive development increased with nitrogen intake during feeding and the preoviposition period for weevils feeding on seedlings and logs was ~ 13 days and 46 days, respectively. Analysis of weevil mortality and of the weight gain of surviving weevils suggests that a nitrogen content of around 0.3% may be limiting for H. abietis. The possibility that nutritionally adequate food resources may be limiting for H. abietis is briefly discussed.

Plasma synthesis of catalytic thin films

Plasma sputter deposition is introduced in the field of catalyst preparation. It is shown that growth kinetics and morphologies are determined by ion to neutral flux ratio and kinetic energies of sputtered atoms. Catalytic activity of such catalysts compares very well with classical catalysts.

mag-1, a homolog of Drosophila mago nashi, regulates hermaphrodite germ-line sex determination in Caenorhabditis elegans

The Caenorhabditis elegans gene mag-1 can substitute functionally for its homolog mago nashi in Drosophila and is predicted to encode a protein that exhibits 80% identity and 88% similarity to Mago nashi (P. A. Newmark et al., 1997, Development 120, 3197-3207). We have used RNA-mediated interference (RNAi) to analyze the phenotypic consequences of impairing mag-1 function in C. elegans. We show here that mag-1(RNAi) causes masculinization of the germ line (Mog phenotype) in RNA-injected hermaphrodites, suggesting that mag-1 is involved in hermaphrodite germ-line sex determination. Epistasis analysis shows that ectopic sperm production caused by mag-1(RNAi) is prevented by loss-of-function (lf) mutations in fog-2, gld-1, fem-1, fem-2, fem-3, and fog-1, all of which cause germ-line feminization in XX hermaphrodites, but not by a her-1(lf) mutation which causes germ-line feminization only in XO males. These results suggest that mag-1 interacts with the fog, fem, and gld genes and acts independently of her-1. We propose that mag-1 normally allows oogenesis by inhibiting function of one or more of these masculinizing genes, which act during the fourth larval stage to promote transient sperm production in the hermaphrodite germ line. When the Mog phenotype is suppressed by a fog-2(lf) mutation, mag-1(RNAi) also causes lethality in the progeny embryos of RNA-injected, mated hermaphrodites, suggesting an essential role for mag-1 during embryogenesis. The defective embryos arrest during morphogenesis with an apparent elongation defect. The distribution pattern of a JAM-1::GFP reporter, which is localized to boundaries of hypodermal cells, shows that hypodermis is disorganized in these embryos. The temporal expression pattern of the mag-1 gene prior to and during morphogenesis appears to be consistent with an essential role of mag-1 in embryonic hypodermal organization and elongation.

Observer variability in measuring elevation and external rotation of the shoulder. Primary Care Rheumatology Society Shoulder Study Group

The aim of the study was to assess the observer variation between trained primary care physicians in their assessment of two key shoulder movements: elevation and external rotation. Six observers each examined and recorded their visual estimate of the range of movements in six patients assessed in random order. There was good agreement on the range of passive elevation assessed to the start of pain (if present): intraclass correlation coefficient (ICC) = 0.84, and to the point of maximum elevation: ICC = 0.95. There was no evidence of an important systematic bias between observers. By contrast, external rotation was poorly reproducible: ICC = 0.43, with important systematic differences between observers. In the second experiment, six observers simultaneously witnessed a range of movements in a single volunteer subject, and the agreement on their visual estimation of the angles achieved was assessed. There was a marked reduction in the systematic bias in external rotation, but agreement was still poor. Agreement for elevation remained high with a reduction in the small amount of bias observed in the first experiment when variability in both examination and visual assessment had been investigated. We conclude that shoulder elevation is a reliable measurement for use in multicentre studies by trained primary care physicians. By contrast, external rotation is poorly reproducible because of systematic variation in examination technique and random variation in visual assessment.

The prevalence of chronic widespread pain in the general population

OBJECTIVE

To establish the prevalence of chronic widespread pain and associated symptoms in a general population sample.

METHODS

Cross sectional postal survey of 2,034 adults in the north of England.

RESULTS

The point prevalence of chronic widespread pain was 11.2%. The symptom was strongly associated with other somatic complaints and with measures of depression and anxiety.

CONCLUSION

In the general population, this cardinal symptom of fibromyalgia is common and identifies a group who are more likely also to report symptoms of fatigue and depression.

Cloning and molecular characterization of a metabolic gene with development functions in Drosophila. I. Analysis of the head function of Punch

In an effort to understand the functions of pterins throughout development we have been studying Punch (Pu), the structural gene for the enzyme GTP cyclohydrolase in Drosophila melanogaster. This enzyme catalyzes the first step in the pterin biosynthetic pathway. The Pu gene product is required for vital functions at two distinct stages in embryogenesis, and a pigmentation function in the eye of the young adult. We have localized the Pu region to 29 kb of DNA through the analysis of lesions present in Pu mutants. Since all of the mutations that were mapped affect the eye pigmentation function of Pu, and since this function is the best defined biochemically, we have concentrated on identifying and characterizing Pu products required for eye pigmentation in our initial examination of the cloned region. Four different transcripts from this region are expressed in the adult head. We show that one of these transcripts, the 1.7-kb species, is responsible for the pigmentation function through the analysis of mutant transcripts and the use of an in vitro translation assay. A 2-kb region lying within the locus is specifically required for this eye pigmentation function.

A cytogenetic analysis of the Punch-tudor region of chromosome 2R in Drosophila melanogaster

Eleven chromosomal deficiencies and several rearrangements in the Pu-tud region of chromosome 2R have been generated and examined cytologically. The Pu locus has been localized to chromosome bands 57C5-6 and tud to 57C7-8. Mutagenesis within the region defined by the deletion intervals has resulted in the isolation of 92 new lethal mutations. Seventy-six of these mutations have been separated into 16 complementation groups that have been ordered and placed cytologically by deletion mapping. All new alleles fully complement tud for both lethal and grandchildless phenotypes. The largest number of new mutations, a total of 25, are Pu alleles.

Relationships among serum immunoglobulin concentration in foals, colostral specific gravity, and colostral immunoglobulin concentration

Postpartum, presuckle, colostrum samples were collected from 100 mares. Colostral specific gravities significantly correlated (r = 0.9) with colostral immunoglobulin (Ig)G concentrations. Foal serum IgG concentrations highly correlated (r = 0.82) with specific gravities of the colostrum each foal ingested. Eight of 48 foals (17%) had serum IgG concentrations less than 400 mg/dl. The dams of these 8 foals had colostral sp gr less than 1.06 and colostral IgG concentrations less than 3,000 mg/dl. Foals had serum IgG concentrations greater than 520 mg/dl 24 hours after parturition, when the colostral specific gravity of the dam was greater than or equal to 1.06. Effects of breed on colostral specific gravity, colostral IgG concentrations, foal serum IgG concentrations, and mare serum IgG concentrations were not significant.

Left ventricular volume from paired biplane two-dimensional echocardiography

To evaluate the applicability of two-dimensional echocardiography to left ventricular volume determination, 30 consecutive patients undergoing biplane left ventricular cineangiography were studied with a wide-angle (84 degrees), phased-array, two-dimensional echocardiographic system. Two echographic projections were used to obtain paired, biplane, tomographic images of the left ventricle. We used the short-axis view (from the precordial window) as an anolog of the left anterior oblique angiogram, and the long-axis, two-chamber view (from the apex impulse window) as a right anterior oblique angiographic equivalent. A modified Simpson's rule formula was used to calculate systolic and diastolic left ventricular volumes from the biplane echogram and the biplane angiogram. These methods correlated well for ejection fraction (r = 0.87) and systolic volume (r = 0.90), but only modestly for diastolic volume (r = 0.80). These correlations are noteworthy because 65% of the patients had significant segmental wall motion abnormalities. The volumes determined from the minor-axis dimensions of M-mode echograms in 23 of the same patients correlated poorly with angiography.

Medical services at a music festival

A three-day open air musical festival attended by approximately 20 000 people was held at Ngaruawahia in January 1973. A medical service was provided and staffed mainly by medical students, nurses and young medical graduates. There were 1998 patient visits to the medical area, the five most common complaints being sunburn, headaches, minor foot trauma, gastroenteritis and lacerations which collectively accounted for 75 percent of the diagnoses. The medical services provided are discussed and recommendations for future festivals made.